Tissue suture clamp



Dec. 18, 1962 c. H. SHELDEN ETAL 3,068,869

TISSUE SUTURE CLAMP Filed oct. 1, 1959 s sheets-sheet 1 30 Z0 fg 43 /mwwif 23 INVENTOR.

Dec. 18, 1962 c. H. sHELDEN ETAL. 3,068,869

TISSUE SUTURE CLAMP Filed Oct. l, 1959 5 Sheets-Sheet 2 IN V EN TOR.

l lax/MKM Dec. 18, 1962 c. H, sHELDEN ETAL 3,068,869

TISSUE SUTURE CLAMP Filed oct. 1, 1959 s sheets-sheet s 5' Hlm/rie imamHwa@ /Q arf-.f

IN VEN TOR.

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United tat-jes Patent @dice Patented Dec. 18, 1962 3,668,869 THSSUESUTURE CLAll/H3 Charles Hunter Shelden, 744 Fairmount, and Harold R.Lutes, 556 Wchigan Blvd., both of Pasadena, Calif. File-d Get. 1, 1959,Ser. No. 843,723 13 Claims. (Cl. 12d-337) The invention relates tosurgical devices and has particular reference to a means for closingwounds which takes the place of conventional stitching. Moreparticularly the invention is concerned with the provision of clips soconstructed that they can be attached to the skin and tissues onopposite sides of a cut, lacera-tion, or wound and the sides of thewound brought together and held together by engagement of the clips witheach other until healing takes place.

For closing wounds the two layer method employing silk sutures has longbeen accepted as standard. Excellent wound healing has been obtained bythis method which comprehends sewing opposite sides of a wound togetherby use of a needle and sutures, the suture being knotted to hold thesides of the wound in position until the healing has been achieved. Itthen, of course, is necessary to cut and withdraw the sutures beforefinal healing takes place. Although satisfactory in many regards,several disadvantages have been obvious. One disadvantage comprehendsundue consumption of time in drawing the sides of the wound together sothat blood loss is more .than desired. Also a considerable amount offoreign material may be left in the wound as, for example, silk fibersfrom the sutures. Buried sutures which are not removed may ultimatelywork to the surface, but Iin the meantime healing is not perfect.

Some time later use was commenced of an inverted mattress suture oftautalum wire employed particularly for closing wounds in the scalp.This method makes use of sewing tantalum wire through opposite sides ofthe wound by use of a curved needle and the ends of wire then twistedtogether to hold opposite sides of the wound in position. Both thetantalum wire method and the suture method emphasize the drawingtogether of both inner and outer layers of tissue so that the healingwill be complete on the inside as well as on the outside.

The tantalum wire technique has been more rapid allowing betterhemostasis when removed and leaving no foreign material in the wound.Stainless wire has since replaced tantalum but the method of use andadvantages are similar.

Even in the last instance, however, the disadvantages of delay persistand sides of a wound drawn together by this technique have not left aperfectly smooth skin surface after healing has been complete, leavinginstead obvious marks of the stitching.

lt is therefore among the objects of the invention to provide a new andimproved apparatus and technique for drawing together the sides of awound in the scalp or elsewhere on the body in a manner which is quick,certain, and effective in the production of a highly desired healing ofthe wound.

Another object of the invention is to provide a new and improved deviceby means of which skin and tissue can be grasped effectively -atlocations on opposite sides ofthe Wound and at the most desiredlocation, thereby making it possible to draw the sides of the Vwoundtogether neatly and to adjust to the proper degree and there holding thesides irmly together for as long a time as may be necessary for completeand proper healing.

Still `another object of the invention is to provide a new and improvedsuture clip which can be quickly inserted through the skin and tissuesby a continuous rapid motion, the device being ci such character thatboth inner and outer layers are grasped effectively, thereby making itpossible to join both layers with a proper degree of pressure sutcientto stop the tlow of blood with the least possible delay and, moreover,to close the wound in such fashion that when healing linally t-akesplace, the wound mark is extremely obscure, the clips, moreover, beingof such construction that the clips themselves once removed do not leavetheir own particular marks.

Also included among the objects of the invention is to provide a new andimproved suture clip device identifiable as a tissue suturing clampwhich can be quickly and effectively applied by a trained individualvirtually without assistance, the clips being capable of iirmlyattaching themselves to each other, thereby to hold the sides of thewound immovably in position once attached, the clips, moreover, being ofsuch construction that they can be manufactured inexpensively, used forlong periods of time, edectively sterilized between uses, and readilymatched together so as to obviate the need for right and left-handelements.

With these and other objects in view, the invention consists in theconstruction, arrangement and combination of the various parts of thedevice, whereby the objects contemplated are attained, as hereinafterset forth, pointed out .in the appended claims and illustrated in theaccompanying drawings.

In the drawings:

:FIGURE 1 is a perspective View lof a pair of clips attached to eachother as they would be in use.

FIGURE 2 is an exploded View showing a pair of clips separated from eachother but in the positions they would have immediately precedinginterengagement and locking together.

vFiGURE 3 is a bottom View of a pair of clips in engaged relationshipwith one of the pair shown in section.

FIGURE 4 is a transverse sectional View showing the sides of an openwound before engagement with the clips `and showing a pair of clips inthe positions of first engagement, one of the clips being partiallybroken away to show .the interior structure.

`FlGURE 5 is a transverse sectional view similar to FGURE 4 showing bothclips securely attached to the sides of the wound and drawn furthertowards each other, thereby to begin the closing of the wound.

FIGURES. 6 is a transverse sectional View similar to FIGURES 4 and 5 butshowing the clips interlocked with each other, thereby holding the sidesof the wound in position for healing.

FIGURE. 7 is a perspective view showing two pairs of clips applied toand closing a wound in the scalp of an individual.

In an embodiment of the invention chosen for the purpose of illustrationa pair of clips 10 and 11 are shown but these clips are identical,thereby obviating the need for providing right-hand and left-hand clips.-Ience, but a single style of clip is needed and as long as there are aneven number of clips, every clip will be capable of use inasmuch as theyare completely interchangeable.

Each clip consists of a somewhat bevelled outer Wall 12, a pair of sidewalls 13 and 14, an upper surface 15 and a lower surface 16. It will benoted that the lower surface is somewhat arcuate in form, therebyenabling it to better conform to the curvature of the body portion wherethe clips are being used. This is especially valuable for scalp woundsto t the contour of the scalp, that being a portion of the body whichdoes not accommodate itself as readily to the application of the clips.

On the side of the clip immediately opposite the outer wall 12 is aninner wall indicated generally by the reference character 17, the innerwall comprising an interlocking edge of special shape. This interlockingedge contains a projection 1S and immediately adjacent the projection 1Sa deep pocket 19 which is complementary in shape to the projection. Onthe side of the projection opposite from the pocket is a shoulder 20 andon the side of the pocket 19 opposite the projection is a shoulder 2i.It will be noted particularly from an examination of FIGURES l, 2 and 3that the projection of the clip 10 is adapted to t snugly within thepocket 19 of the clip 11 and that the projection 18 of the clip 11 isadapted to lit snugly within the pocket 19 of the clip 10. The shoulders26 and 21 of the respective clips 1t) and 11 abut each other on one sideas do the respective shoulders 21 and 20 on the other side.

On the side wall 13 of each clip is a slot 22. The slot 22 is identicalwith a slot 23 in the side wall 14 and when two clips are broughttogether, as shown in FIGURES 1 and 3, the slots form a singlekcontinuous slot.

Located in the slot 22 is an arm or hoek arm 24 which is pivotallysecured in the slot by use of a rivet 25. The arm has a hooked end 26and in the hooked end is an opening 27 which is adapted to engage aroundthe shank 28 of a rivet 29 in the slot 23. This engagement is clearlyshown in FIGURE 3. To further facilitate manipulation of the arm is afinger grip 30 which consists of a bentover portion of the arm so formedand located that it overlies the adjacent side walls 13 and'14 when thearm is engaged. In engaged position virtually all of the arm 24 isreceived within the slots 22 and 23 except the overlying linger grip 30.

Adjacent the projection 18 and pocket 19 `of the clip and on theunderside adjacent the lower surface 16 is a recess 31 which extendsentirely across the clip from one side wall 13 to the other side wall14. The upper arcuate shape of the recess 31 clearly appears in FIGURESl and 4 through 6.

On the underside of each clip and extending outwardly of the lowersurface is a series of sharp teeth. These teeth` are arranged in sets oftwo, there being provided a pair of long teeth 32 and 33 and a pair ofshort teeth 34 and 35. The precise arcuate shape of the teeth is ofsingular importance and the shape in general is shown to good advantagein FIGURES 4, and 6. As there shown the long teeth 32,V 33 have innerends 36 recessed and embedded in the body of the clip. It should beadded that clips of the kind herein described are advantageously made byany one of a number of synthetic plastic resinous materials which are ofsuch character that they can be used in contact with the body withoutany prospect of harmful eiects. The outer portion of the long teeth 32,33 consists of a gently curved mid-portion 37 and a tip 38 which isturned at a smaller radius of curvature.

Similarly the short teeth 34, 35 have each a recessed inner end 39effectively embedded in the plastic of the clip itself. The teeth havean outwardly extending midportion 41 having a relatively large radius ofcurvature and a tip 42 curved to a slightly different degree, asshown inFIGURE 4, which is a curvature substantially different from thecurvature of the tip 38 of the long teeth.

In the body portion-of the clipis a hole 43 which extends entirelythrough the clip and permits a view from one side through to the other.

When the clips are to be applied, the following method is found mostacceptable. The longer teeth 32, 33 of each of a pair of clips and 11are inserted iirst, using a motion that is down and at the same timetoward the scalp margin, assuming for the sake of example only thatVdownwardly until the short teeth 34, 35 engage the tissues. It will benoted that the tissues are very approximately indicated as consistingpredominantly of an outer layer 46 and an inner layer 47, although inpractice there may be multiple layers not as clearly defined as in theexample given.

It should further be noted that the full distance between the tip 38 -ofeach long tooth and the lower surface 16 of the clip is something lessthan the aggregate thickness of the inner and outer layers 46 and 47. Itwill further be noted that the distance between the tip 42 of the smallteeth and the lower surface 16 is slightly less than the thickness ofthe outer layer 46.

Subsequent to engagement of the teeth with the outer and inner layers ofskin, as illustrated in FIGURE 5, clips opposite each other are drawntogether to the positions illustrated in FIGURE 6. It will be noted thatin these positions the outer and inner layers adjacent the edges 44 and45 are bulged outwardly slightly and that the recess 31 in each instance-receives thev bulged portion of thev joined edges 44, 45.

In the positions there illustrated the arms 24 of the respective clipsare pivoted from outer positions illustrated in FIGURE 2 to innerpositions illustrated in FIGURES laterally with respect to each otherand also cannot shift vertically with respect to each other due in thelast instance to the engagement of the arms inthe slots. Hence, once theinterlock is accomplished, the clips will remain firmly attachedtogether and will not permit the wound to be disturbed. v Y

Once healing has finally taken place and the clips are to be removed,the arms are lirst disengaged and then each clip is lifted fromposition, thereby causing the teeth to be withdrawn. The puncturewounds'of `the teeth are virtually insignicant and leave no scar. EX-cellent hemostasis results even in individuals having extremely vascularscalps. On numerous occasions where these clips have been employed, theforehead limb of transfrontal craniotomies have been closed by usingonly two clips without galeal or subcutaneous sutures. Healing has beenexcellent and aspiration of a wound following the use of clips has neverbeen necessary. Although the more ditlicult applications have been forthe closure of craniotomy wounds, it is of practical value to employ theclips in the closure of traumatic scalp lacerations with a minimum ofequipment, time and assistance. It is only necessary to clip thehairshort for an inch or so on each side of the wound and shave the one-halfinch along the margins of the wound. This allows for more satisfactoryapplication of the short teeth, thus allowing better eversion andapproximation of the scalp margins. A group of three or four pairs ofclips, which may be enough to close a six to eight inch scalplaceration, can be placed in a metal, plastic or suitable sterilizingmaterial, sealed in a sterile glass tube, and made available forimmediate use in an emergency room or carried as emergency equipment onambulances or in a physicians bag.

Although primary attention has been given to scalp wounds, it isunderstood that wounds on various other locations'on the body can beclosed equally effectively with clips of the type herein described,having virtuallyY the same shape and description lor modified to aslight degree, depending upon the character of the surface` of the bodywhere the wound is encountered. The clips are relatively small andalthough the size 'is not critical, clips n of less than about one inchsquare have been found advantageous.

Although we have herein shown and described our invention in what wehave conceived to be the most practical and preferred embodiment, it isrecognized that departures may be made therefrom within the scope of ourinvention, which is not to be limited to the details disclosed herein,but is to be accorded the full scope of the claims so as to embrace anyand all equivalent structures and devices.

Having described our invention, what we claim as new and desire tosecure by Letters Patent is:

l. A device for closing wounds during the healing period comprising apair of individual separate matched clips having faces adapted to lieadjacent opposite sides of the wound, said clips having elongated edgesin face to face engagement when assembled and having matching lockingmeans respectively for said edges adapted to interlock one with theother when in use, sharp projections extending outwardly of said facesfor engaging tissue on opposite sides of the Wound and fastening meansacting between the clips adapted to hold the clips together in woundclosing position.

2. A device for closing wounds during the healing period comprising apair of matched clips having faces adapted to lie adjacent oppositesides of the wound, said clips having locking edges adapted to interlockone with the other when in use, sets of separate long and short sharpprojections of similar contour and configuration extending outwardly ofsaid faces, said short projections having bases thereof located adjacentthe respective locking edge and being adapted to engage outer layers oftissue and said long projections having bases thereof located moreremotely from the respective locking edge and said long projectionshaving tips thereof adapted to engage inner layers of tissue on oppositesides of the wound, and fastening means acting between the clips adaptedto hold the clips together in wound closing position.

3. A device for drawing multiple outer and inner layers of skin tissuetogether to close opposite sides of a wound during the healing periodcomprising a pair of matched substantially identical clips having bodycontacting faces adapted to lie adjacent opposite sides of the wound,said clips having adjacent elongated interlocking edges in releasableengagement with each other when in use and each said clip having aplurality of separate teeth projecting outwardly from the bodycontacting face having curved pointed tips, certain of said teeth havingsaid curved tips at a relatively lesser distance from said face enablingpenetration only of the outer layers of skin, and certain other teethhaving said curved tips at a greater distance from said face enablingpenetration into the inner layers of skin, said tips of said teeth beingcurved generally toward said interlocking edge, and fastening meansacting between opposite interlocked clips for holding said clips and therespective sides of the wound together.

4. A device for drawing multiple outer and inner layers of skin tissuetogether to close opposite sides of a wound during the healing periodcomprising a pair of matched substantially identical clips having bodycontacting faces adapted to lie adjacent opposite sides of the wound,said clips having adjacent elongated interlocking edges in releasableengagement when in use and each said clip having a plurality of sets ofseparate teeth projecting outwardly from the body contacting face andhaving curved tips directed inwardly toward the respective edge, one setof teeth lying adjacent the interlocking edge having a relativelyshorter length enabling penetration of the tips to only the outer layersof skin, another set of relatively longer teeth lying further removedfrom said interlocking edge and having a length enabling penetration ofthe tips into the inner layers of skin, and releasable fastening meansacting between opposite interlocked clips for hold- 6 ing said clips andthe respective sides of the wound together.

5. A device for drawing multiple outer and inner layers of skin tissuetogether to close opposite sides of a wound during the healing periodcomprising a pair of matched substantially identical clips having bodycontacting faces adapted to lie adjacent opposite sides of the wound,said clips having adjacent interlocking edges when in use and each saidclip having a plurality of sets of teeth projecting outwardly from thebody contacting face, one set of teeth lying adjacent the interlockingedge having a relatively shorter length enabling penetration only of theouter layers of skin, another set of relatively longer teeth lyingfurther removed from said interlocking edge and having a length enablingpenetration into the inner layers of skin, said teeth having tipsthereof curved generally toward said interlocking edge, each said facehaving a longitudinal portion of a recess along the interlocking edgeadapted to match the longitudinal portion of the recess of the otherclip for reception of outer portions of the skin when the wound isclosed, and fastening means acting between opposite interlocked clipsfor holding said clips and the respective sides of the wound together.

6. A device for drawing together multiple outer and inner layers of skintissue of a body member together to close opposite sides of a woundcomprising a pair of duplicate matched clips having body contactingfaces adapted to lie adjacent opposite sides of the wound and havingsaid faces substantially conforming to the surface of said body member,opposite side walls on the clip, mutually interlocking edge elements onsaid clips having a relationship when engaged interlocked againstlateral and vertical shifting, a plurality of sharp teeth projectingfrom the body contacting face of each clip having tips thereof curvedtoward the respective mutually interlocking edge elements, saidinterlocking elements including fastening means for holding said clipstogether, said fastening means comprising a hook arm pivotally mountedin one clip having a hooked end receivable in the clip opposite theretowhen in use, means in said clip opposite thereto adapted to receive saidhooked end when the arm is engaged therewith.

7. A device for drawing multiple outer and inner layers of skin tissuetogether to close opposite sides of a wound comprising a pair ofduplicate matched clips having body contacting faces adapted to lieadjacent opposite sides of the wound, mutually engaging edges on saidclips having an interlocked relationship when engaged, a plurality ofsharp teeth projecting from the body contacting face of each clip havingtips thereof curved toward the respective mutually engaging edge, andfastening means for holding said clips and sides of the Wound together,each said. clip comprising opposite side walls extending away from themutually engaging edge, said fastening means comprising means formingretention elements in said side walls, a hook arm pivotally mounted inthe retention element of one clip having a hooked end receivable in thecorresponding retention element of the clip opposite thereto when inuse, and a finger grip on each hook arm projecting outwardly of theretention element when in use.

8. A device for drawing multiple outer and inner layers of skin tissuetogether to close opposite sides of a wound comprising a pair ofduplicate matched clips having body contacting faces adapted to lieadjacent opposite sides of the wound, irregular mutually engaging edgeson said clips having an interlocked relationship when engaged, aplurality of sharp teeth projecting from the body contacting face ofeach clip having tips thereof curved toward the respective mutuallyengaging edge, and fastening means for holding said clips and sides ofthe wound together, each said clip comprising opposite side wallsextending away from the mutually engaging edge, said fastening meanscomprising means forming matching slots in said side walls, a hook armpivotally mounted U in the slot of one clip having a hooked endreceivable in the corresponding slot of the clip opposite thereto whenin use, a rivet in said corresponding slot adapted to receive saidhooked end when the arm is in the respective slot and a finger grip onthe side of each hook arm projecting outwardly of the slot when in use.

9. A device for closing wounds during the healing period comprising apair of matched clips having faces adapted to lie adjacent oppositesides of the Wound, sharp projections extending outwardly of said facesfor engaging tissue on opposite sides of the wound and fastening meansacting between the clips adapted to hold the clips together in woundclosing position, said sharp projections comprising curved teeth havinglongitudinal axes thereof of varied curvature wherein the radii diminishprogressively from a relatively great radius at the face outwardly to arelatively small radius at the outermost end.

10. A device for closing wounds during the healing period comprising apair of identical clips having smooth contoured faces adapted to overliesubstantial portions of the body adjacent opposite sides of the wound,sharp projections extending outwardly of said faces for engaging tissueon opposite sides of the wound and interlocking releasable fasteningmeans on opposite sides of the clips acting between the clips adapted tohold the clips together in wound closing position, and means forming`drainage holes located in mid-areas of the faces and extending betweenthe face of each clip adjacent the wound and a face opposite thereto.

11. A device for closing wounds during the healing period comprising apair of identical clips having smooth contoured outside and insidefaces, said inside faces being adapted to lie adjacent opposite sides ofthe wound, sharp tion of the human body whereupon the clips are usedwhereby to reduce local swelling.

12. A device for closing wounds during the healing period comprising apair of separate matched identical clips, each clip having a bodycontacting face adapted to lie adjacent one side of a wound, a matchingedge thereof adapted to face the wound and transverse sides thereofextending transversely relative to said matching edge, and an identicalclip on the opposite side thereof, a matching edge on said last clipwhen in use being in contact with said rst matching edge, and identicalreleasable fastening means on respective transverse sides of each clip,said fastening means when in use being in engagement with said identicalclip on the relative opposite transverse side.

13. A device for closing wounds during the healing period comprising apair of matched identical clips, each clip having a body contacting faceadapted to lie ad-V jacent one side of a wound, a matching edge thereofadapted to face the Wound and an identical clip on the opposite sidethereof and identical releasable and rigid fastening means adapted toengage said identical clip on the opposite side, and means forming aportion of a recess along the matching edge adjacent said bodycontacting face, said portion in operative position forming a recess ofpredetermined limited depth receptive of a bulge of tissue formed duringhealing of the wound.

'References Cited in the file of this patent Y UNITED STATES PATENTS268,632 Danforth Dec. 5, 1882 583,455 Bush June 1, 1897 2,254,620 MillerSept. 2, 194.1 2,472,009 Gardner May 3l, 1949 2,669,747 Deturanto Feb.23, V1954 FOREIGN PATENTS 253,445 Italy June 17, 1927 16,715 AustriaJuly 13, 1903 418,970 France Oct. 1 4, 1910

